Pay, hassles have doctors turning away older patients.

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A woman we'll call Ellen (not her real name) told a reporter lately about her trouble finding a gynecologist in Little Rock who would accept Medicare. Her own doctor, whom she'd seen for eight or nine years, had "dumped" her, saying she was no longer accepting Medicare reimbursement.

Ellen said it reminded her of the situation in the 1960s, when the Medicare law was first passed: It was common to see "We do not accept Medicare" signs in doctors' offices. Eventually, they did accept — but 50 years later, participation is declining.

Ellen was looking for a female gynecologist, which narrowed her field. There are gynecologists who accept Medicare, but many don't. A quick (and unscientific) survey of private practice ob/gyns physicians in the Little Rock phonebook found eight doctors who do not participate in the single-payer government system and 15 who did, though one of them was not accepting new gynecological patients.

Dr. Karen Kozlowski, an ob/gyn winner in a previous Best Doctors survey, recently dropped her Medicare patients. She did so "because it's a pain in the ass dealing with the government," she explained.

"You work your tail off, jump through all kinds of hoops to satisfy requirements that may or may not have anything to do with good patient care. And to be honest, reimbursement sucks," Kozlowski said. She said she is providing her former patients information on Medicare providers, information that is also online at medicare.gov/find-a-doctor.

Kozlowski said anticipated future hassles — including the requirement that she go to electronic medical records — was another reason she dropped Medicare.

Kozlowski's specialty is not the only one losing Medicare providers. The loss is across the board, David Wroten, director of the state Medical Society said. "The formula that Medicare uses to determine what it's going to pay physicians is a mess," Wroten said, one that Congress has not had the "intestinal fortitude" to fix.

Uncertainty over reimbursement — and questions about what the future holds — "drives physicians up the wall," said Dr. Joe Thompson, director of the Arkansas Center for Health Improvement. Since 1997, the balanced budget amendment has required that payments to doctors be ratcheted down every year — but that reduction has never happened. "Each and every year, Congress has come along and put a Band-Aid [on the amendment] and said they were not going to implement" the reduction, Thompson said.

This year, the Band-Aid came late twice, leaving doctors without Medicare reimbursement for several weeks. The program's administration, Dr. Brad Baltz said, "is an absolute disaster."

Baltz, one of the top hematologist/oncologists named in this year's Times survey, said he went without reimbursement for six weeks this year because of congressional and Medicare system delays. His cost of chemotherapy drugs runs $250,000 a week. To pay the bills, he had to take out a loan and increase patient load. Sixty percent of his patients are seniors on Medicare.

The country's health insurance system overall, Baltz said, "is beyond fixable," a problem that will "take some really smart people who see both sides of the road" to alleviate. He said he'd "absolutely" support a single-payer system, eliminating insurance companies and letting the government administer health care. The benefit: One payer with one set of rules and policies for allowed procedures, access to care and payment. "We're working for the government anyway," Baltz said. But, he noted, the American insurance industry will never let it happen.

The Medical Society's Wroten said Congress' shorter fixes — delaying cuts for a few months rather than a year or 18 months — have kept doctors guessing. A cut of 21 percent in Medicare reimbursement could go into effect in November if Congress decides to apply no more Band-Aids.

Wroten said his office is hearing weekly from patients who can't find a Medicare provider and from physicians whose parents or other family members can't find a provider, especially in Little Rock. The AMS hasn't conducted a survey to get a number on how many doctors are no longer accepting Medicare reimbursement, he said, because "it's so obvious," but a survey by the American Academy of Family Physicians cited in USA Today found that 13 percent of its respondents in 2009 did not participate in the Medicare program, an increase from 8 percent in 2008 and 6 percent in 2004.

Arkansas physicians get hammered another way, Wroten said: Medicare reimbursement is based on regional factors, and Arkansas's is the lowest in the nation. "It hurts us on recruitment, and it hurts us on physicians willing to treat Medicare patients."

In its survey, the Times asked doctors who are taking new patients if they accept Medicare reimbursement. A huge majority indicated they are — 153 doctors, 84 percent of those who chose to respond to the question.

But 40 doctors (78 percent of those who chose to respond the question) who indicated they previously accepted Medicare patients no longer do.

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